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<title>Registration with Getub</title>
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<form id="registerForm" name="registerForm" method="post" action="#">
  
  <div class="back">
  <div class="footerBg">
  <div id="frame">
  <div class="header">
  <div class="topnavi">
  <a href="#"><img src="../../images/img/login_btn_02.gif" /></a>
  <a href="#"><img src="../../images/img/register_btn_04.gif" /></a>
  </div><!--topnavi-->
  <a href="#"><div class="logo"></div></a><!--logo-->
  <div class="mainnavi">
  <ul class="navi"><li><a href="../../index.html">Home</a></li><li><a href="#">Buy Books</a></li><li><a href="#">Sell Books</a></li><li><a href="#">Community</a></li><li class="li"><a href="#">About</a></li></ul>
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  <div class="mainfrm">
  <div class="bluestripfrm">
  <div class="regwith"></div>
 
  
  </div><!--bluestripfrm-->
  
  <div class="formframe">
  <div class="formheading1"></div>
  
  <div class="formsection">
   <div class="formrowrg">
	<div class="form-row">
	<div class="field-label">
    <label for="field1-t2">Name</label>:</div>
	<div class="field-widget">
    <input name="field1-t2" id="field1-t2" class="required" title="Enter your name. This is a required field" />
    </div>					
    </div>
	
  <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Last Name<span style="color:#FF9000;">* </span></span><span class="left"></span><span class="center"><input id="lastName" name="lastName" type="text" class="textbox" /></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Phone</span><span class="left"></span><span class="center"><input name="phone_area" type="text" class="textboxph1" /></span><span class="right"></span>
  <span class="left"></span><span class="center"><input name="phone_2" type="text" class="textboxph2"  /></span><span class="right"></span>
  <span class="left"></span><span class="center"><input name="phone_2" type="text" class="textboxph3" /></span><span class="right"></span>
  </div>
  </div><!--fieldfrm-->
  

  
  </div>
  

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  <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span  style="margin-left:19px;">Address</span><span style="color:#FF9000;">* </span></span><span class="left"></span><span class="center"><input name="" type="text" class="textbox" /></span><span class="right"></span></div>
  
  </div><!--fieldfrm-->
 
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span  style="margin-left:19px;">City</span><span style="color:#FF9000;">* </span></span><span class="left"></span><span class="center"><input name="" type="text" class="textbox" /></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
  
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span  style="margin-left:19px;">State</span><span style="color:#FF9000;">* </span></span><span class="left"></span>
  <span class="center">
  <label>
    <select name="select" class="dropboxstate" >
<option>AL</option>
<option>AK</option>
<option>AZ</option>
<option>AR</option>
<option>CA</option>
<option>CO</option>
<option>CT</option>
<option>DE</option>
<option>FL</option>
<option>GA</option>
<option>HI</option>
<option>ID</option>
<option>IL</option>
<option>IN</option>
<option>IA</option>
<option>KS</option>
<option>KY</option>
<option>LA</option>
<option>ME</option>
<option>MD</option>
<option selected="selected">MA</option>
<option>MI</option>
<option>MN</option>
<option>MS</option>
<option>MO</option>
<option>MT</option>
<option>NE</option>
<option>NV</option>
<option>NH</option>
<option>NJ</option>
<option>NM</option>
<option>NY</option>
<option>NC</option>
<option>ND</option>
<option>OH</option>
<option>OK</option>
<option>OR</option>
<option>PA</option>
<option>RI</option>
<option>SC</option>
<option>SD</option>
<option>TN</option>
<option>TX</option>
<option>UT</option>
<option>VT</option>
<option>VA</option>
<option>WA</option>
<option>WV</option>
<option>WI</option>
<option>WY</option>
    </select>
    </label>
  </span>
  <span class="right"></span>
  <span class="labelzip">Zip Code<span style="color:#FF9000;">* </span></span><span class="left"></span><span class="center"><input name="" type="text" class="textboxzip" /></span><span class="right"></span>
  </div>
  </div><!--fieldfrm-->
  
  </div><!-- End formrowrg right-->
 
  </div><!--end of formsection1-->
  
  <div class="formheading2"></div>
  <div class="formsection">

  <div class="formrowrg">
  <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Email<span style="color:#FF9000">* </span></span><span class="left"></span><span class="center"><input name="email" type="text" class="textbox" />
  </span></div>
  </div><!--fieldfrm-->
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Confirm Email<span style="color:#FF9000">* </span></span><span class="left"></span><span class="center"><input name="email" type="text" class="textbox" /></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label">Your UMass<span style="color:#FF9000">* </span></span><span class="left"></span>
  <span class="center">
   <label id="university">
    <select name="select" class="dropbox" >
	<option selected="selected">-- Select One --</option>
    <option >UMass Amherst</option>
    <option>UMass Boston</option>
    <option>UMass Dartmouth</option>
    <option>UMass Lowell</option>
    <option>UMass Worcester Medical</option>
    </select>
    </label>
  </span>
  <span class="right"></span>
  </div>
  </div><!--fieldfrm-->
  
    </div><!--end of left col section 2-->
	
	 <div class="formrowrg">
   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label"><span  style="margin-left:19px;">Password</span><span style="color:#FF9000">* </span></span><span class="left"></span><span class="center"><input name="password" type="password" class="textbox" /></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  

   <div class="fieldfrm">
  <div class="textboxfrm"><span class="label2">Confirm Password<span style="color:#FF9000">* </span></span><span class="center">
  <input name="password" type="password" class="textbox" /></span><span class="right"></span></div>
  </div><!--fieldfrm-->
  
  
   </div><!--end of right col section 2 -->
  
  
  
  </div><!--end of formsection2-->
  <div class="formheading3"></div>
   <div class="formsection">
   <div class="capfrm">
    <script type="text/javascript"
     src="http://www.google.com/recaptcha/api/challenge?k=6LcIesESAAAAAGeEfP8_L-tw8vLDmnll-RCxx7oy">
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         height="300" width="500" frameborder="0"></iframe><br>
     <textarea name="recaptcha_challenge_field" rows="3" cols="40">
     </textarea>
     <input type="hidden" name="recaptcha_response_field" value="manual_challenge" />
  </noscript>
<div class="radiocheck"><input name="termscheck" class="radiochkbox" type="checkbox" value="" />I accept the <a href="#">Terms of Use</a> and <a href="#">Privacy Policy</a></div>
   </div>
   <div class="submitfrm">
   <div><input type="submit" value="" name="Submit" id="submit" class="submit2" /></div>
   </div>
   </div><!--end of formsection3-->
 
  </div><!--formlftcol-->
  
  
  </div><!--mainfrm -->
 
   <div class="footer">
        <div class="footLeft">copyright &copy; 2011 GetUB. All rights reserved&nbsp;</div>
        <div class="footRight"><a href="#">Terms of use</a>&nbsp;|&nbsp;<a href="#">Privacy Policy</a> </div>
      </div><!--footer-->
	   </div><!--frame-->
  </div><!--footerBg-->
  </div><!--back -->
</form>
<script type="text/javascript">
						function formCallback(result, form) {
							window.status = "valiation callback for form '" + form.id + "': result = " + result;
						}
						
						var valid = new Validation('test', {immediate : true, onFormValidate : formCallback});
						Validation.addAllThese([
							['validate-password', 'Your password must be more than 6 characters and not be \'password\' or the same as your name', {
								minLength : 7,
								notOneOf : ['password','PASSWORD','1234567','0123456'],
								notEqualToField : 'field1'
							}],
							['validate-password-confirm', 'Your confirmation password does not match your first password, please try again.', {
								equalToField : 'field8'
							}]
						]);
					</script>
<script type="text/javascript">
var valid2 = new Validation('registerForm', {useTitles:true});
</script>
</body>
</html>
